Running head: SCOPE AND STANDARDS

Scope and Standards of Practice for the Medical/ Surgical Nurse

Amanda Hubbard
Ferris State University

Abstract

SCOPE AND STANDARDS

The scope and standards of practice for medical-surgical nurses as well as
professional performance standards are defined and broken down from a practice
stand point. The purpose of this is to assess current standards of self-practice with
national standards. Goals and time frames are discussed for standards that are not
being met and examples are given for standards that have been met.
Keywords: medical-surgical, scope and standards of care, and professional
performance standards

SCOPE AND STANDARDS

Scope and Standards of Practice for the Medical/ Surgical Nurse

Every type of nursing has a scope and standards of practice to which the nurse should live
by. These standards are there to guide the nurses practice in the field in which they work.
Medical/ Surgical (med/surg) nursing is no exception. These nurses have a set of standards which
hold them accountable to their patients. Knowing these standards helps the nurse to care for their
patients in the best possible way. These standards of practice will be discussed along with how
they are used in practice and if they are not being used, how they can be implemented.
Academy of Medical-Surgical Nurses Scope and Standards of Nursing Practice
Standards of Care
Assessment. The first step in any nurses practice is assessment of the patient. This does
not just include the physical assessment. According to the Academy of Medical-Surgical Nurses
(AMSN), Scope and Standards of Medical-Surgical Nursing Practice (2012), Medical-surgical
nurses integrate data from a wide variety of sources including interviewing, functional
assessment, environmental assessment, physical assessment, and review of health care records,
(pg. 11). This standard of care should be met by every nurse who comes in contact with a
patient. When first receiving a patient whether it be an emergency room (ER) admit, a direct
admit or a fresh surgical patient, the nurse collects as much data as possible in order to get the
full picture of what is happening to the patient.
The physical assessment maybe the first thing a nurse assess when receiving a patient,
but it is not always the only thing that needs to be assessed. After receiving a patient with a hip
fracture from surgery, the patient went through the admission and physical assessment with no
problems until they were asked about being afraid or abused by someone in their life. The patient

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asked what would happen if she was afraid of someone. This set off red flags. Upon doing the
physical assessment the patient had bruises all over. It was assumed they were from the fall. It
was explained to the patient that everything would be done to remedy the fear and make sure the
patient was safe and cared for. At this point the family came in and the patient did not say
anymore. Once the family left, the conversation resumed and the patient divulged that they were
afraid of the son-in-law. The patient was made aware that whatever was said would be kept as
discreet as possible but it would need to be discussed with people that could help get the care
they deserved. Social services were contacted along with the local authorities. The patient after
three days was going back home to a place where they could feel safe once again. Had the
psychological section of the assessment been ignored or if it was assumed that the patient did not
have any issues in this aspect, this patient may not have gotten the care that they truly needed. To
stay competent in the assessment standard of care, the assessment needs to address not just the
physical portion but every aspect of a patients well-being.
Diagnosis. The second standard of care is diagnosis. The AMSN states that Medicalsurgical nurses analyze the assessment data in determining diagnosis, (pg. 11). In todays
technological age, most of the nursing diagnoses are generated automatically from assessment
data. As the patients status changes the nurse needs to be aware of different nursing diagnoses
that exist to incorporate into the patients plan of care. To stay competent the nurse needs to stay
up to date on new nursing diagnoses and make sure that if there is not a diagnosis that fits the
patient that they help to find one that does. Sometimes, information systems (IS) departments do
not necessarily keep up with new diagnoses. In
Outcome Identification. Medical-surgical nurses identify expected outcomes unique to
the client, (AMSN, Scope and Standard of Medical-Surgical Nursing Practice 2012, pg. 12).

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Outcomes come from the nursing diagnosis, are related to the patients current and future
capabilities and provide direction for care of the client. With a fresh post-operative total knee
patient, the goals are laid out for them before surgery even takes place. The day of surgery the
goal is to sit at the side of the bed. That is written on the white board before the patient even
comes back from surgery. To keep the patient informed of the goals and the nurse competent in
goal setting, the nurse needs to keep up with new evidenced-based practices (EBP) that come out
and make sure that the patient is aware of the goals that will lead them to quality life outcomes.
Planning. Medical-surgical nurses develop a plan of care that prescribes interventions to
attain expected outcomes, (AMSN 2012, pg. 12). Every patient is different; therefore, every
plan of care is different. Plans of care ensure that every nurse is providing continuity of care and
are based on the newest EBP. Plans of care are also generated by admission information and
doctors orders. All of the surgical patients that are admitted have to be screened for
anticoagulant protocols. If the patient is a joint surgery or an open abdominal surgery,
anticoagulants must be started within twenty-four hours of anesthesia end time. The plan of care
would need to be revised to include an anticoagulant if one is not ordered. To stay competent
nurses must be up to date on EBP in order to plan for better outcomes.
Implementation. Medical-surgical nurses implement the interventions identified in the
plan of care, (AMSN 2012, pg. 13). In the previous example, the doctors have standing orders
that can be used to order the anticoagulants. The nurse needs to find the surgical end time on the
operating room (OR) record and order the doctors preferred anticoagulant and administer it to the
patient within twenty-four hours. To stay competent the nurse needs to stay up to date with the
doctors orders, along with their safety and skill levels as well.

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Evaluation. Medical-surgical nurses evaluate the clients progress toward attainment of

outcomes, (AMSN 2012, pg. 13). Evaluation of the outcomes is a constant, on-going endeavor.
Patient status is constantly changing and the nurse needs to be aware of the status changes and
revise outcomes based on those changes. Pain medication and timing is an on-going endeavor
with surgical patients. When a pain medication is given, the nurse has ninety minutes to
reevaluate the patients pain. If the pain is controlled you continue with the medication, maybe at
first keeping it almost scheduled and then increasing the time frame of the medication until the
pain is gone or tolerable. If the medication is not working, then changing a medication or
combining some medications would be the next step and then evaluation would start over again.
The nurse, in order to stay competent needs to reassess the patient and make changes to
outcomes and plans of care.
Standards of Professional Performance
Quality of Care. The medical-surgical nurse systematically evaluates the quality and
effectiveness of nursing practice, (AMSN 2012, pg. 15). Most nurses are constantly trying to
figure out how to do things to make them better for their patient. Even before a patient is
discharged, quality of care is being assessed. This is a standard that will be an ongoing goal.
Within the next year, this goal will be further obtained by being part of the professional nurse
council. This council helps to address on-going policy and procedures to ensure standards for all
nurses to provide a high quality of care.
Performance Appraisal. Medical-surgical nurses evaluate their own nursing practice in
relation to professional practice standards, statues, and regulations, (AMSN 2012, pg. 15).
Again nurses evaluate their practice with every patient encounter. Performance appraisals are

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thought of when they are given and not really reconsidered until the next year. This is due to
management being overly critical of staff. With the next performance appraisal that is due in
August, the goals that are mentioned will be considered and practice habits changed to meet the
goals.
Education. Medical-surgical nurses acquire and maintain current knowledge in nursing
practice. Medical-surgical nurses pursue knowledge to enhance nursing expertise and advance
the profession, (AMSN 2012, pg. 16). Nurses can obtain new knowledge through research of
evidence based practice to increase quality of patient care. In the next year, graduation with a
Bachelors of Science in Nursing (BSN) will be obtained and a Master Degree is a few years off.
Within the next year, certifications in chemotherapy administration will be obtained as well.
Collegiality. Medical-surgical nurses interact with, and contribute to, the professional
development of peers and other health care providers as colleagues, (AMSN 2012, pg. 16).
Most nurses have the opportunity to help student nurses during their clinical rotations. Some
nurses even have the opportunity to mentor new nurses in the workplace. Within the next six
months, obtainment of the class to become a nurse trainer will be scheduled and completed.
Ethics. Medical-surgical nurses deliver care in a nonjudgmental, nondiscriminatory,
sensitive, and culturally competent manner, (AMSN 2012, pg.17). Nurses are taught from the
beginning to be compassionate and nonjudgmental. Within the last six months, the opportunity
arose to care for a correctional patient. This was a bit of a scary situation. Those feelings were set
aside and the patient received the same care that any other patient would receive. Client
diversity is an on-going goal. As new patients arrive with different diversities, the more that is
learned for the next patient that comes in.

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Collaboration. Medical-surgical nurses collaborate with the client, family members,

significant others, and health care providers, (AMSN 2012, pg. 18). Collaboration is something
that is done on a daily basis. During multidisciplinary rounds all aspects of patient care is
addressed. Collaboration comes in especially when a cancer patient has realized that their life is
limited and wants to go home to die. It takes the nurses, doctors, hospice coordinator, social
services, discharge planning and the facilities on the outside to coordinate getting the patient
home with the needed equipment so that the patients wishes can be met.
Research. Medical-surgical nurses use research findings in practice, (AMSN 2012, pg.
18). Nurses use research results in their everyday practice. EBP is what we all use to implement
patient care. Within the next few months, the opportunity to receive EBP materials to actively
keep up on new research will be obtained. Once obtained, the research that is found will be used
to change current nursing practices to provide a higher quality of care.
Resource Utilization. Medical-surgical nurses consider factors related to safety,
effectiveness, and cost in planning and delivering client care, (AMSN 2012, pg. 19). Cost is one
of the biggest issues affecting bottom lines in all of health care. Nurses must do more with less
and still provide safe, quality care. At Memorial Health Care, a new charging system was
implemented for supplies. The nurse or tech only scans certain items that the facility charges the
patient for. Intravenous (IV) solutions and dressing supplies are a few things that are chargeable;
syringes and needles are not. Injection supplies are figured into the daily cost of care. It was
brought to all of the nurses attention that IV fluids can cost as much as $30.00 a bag. After that,
nurses started letting the bags finish out instead of leaving a couple hundred milliliters in it and
changing it out due to convenience.

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Communication. Medical-surgical nurses communicate effectively with clients,

families, and other health care professionals, (AMSN 2012, pg. 19). Communication is a must
with all health care workers, not just nurses. Nurses however are on the frontlines. They must
communicate with patients, families, doctors and other healthcare workers in order to provide
quality care to the patient. Communication is an on-going, everyday struggle for most of the
multidisciplinary team. By May, the information on communication learned in this class will
help with that struggle.
Leadership. Medical-surgical nurses use leadership skills to enhance client outcomes
and foster a healthy work environment within the practice setting and profession, (AMSN 2012,
pg. 20). Leaders in nursing help to educate, motivate, and mentor staff in the hopes of making
patient outcomes better. Nurse leaders help to build up the team, resolve conflict and in general
display how a nurse should conduct themselves. Leadership skills are currently being acquired as
this course continues. Over the next several years, skills and knowledge obtained through
education, research, professional development committees will help to become a quality staff
member and leader.
Conclusion
All nurses upon graduating from nursing school should be familiar with nursings scope
and standard of practice. Once the nurse hires in to a facility, the nurse needs to maintain those
standards for the field of nursing that they are pursuing. Standards of professional performance
come with time, education, and the willingness to be better than you were in a previous situation.
The standards of practice and professional performance standards are all guidelines in order to
promote the nurse in providing high quality, competent care.

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10
References

Academy of Medical-Surgical Nurses (2012). Scope and Standards of Medical-Surgical Nursing

Practice (5th ed.). Retrieved https://www.amsn.org/sites/default/files/documents/practiceresources/scope-and-standards/AMSN-Scope-Standards-MS-Nursing.pdf.